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The relationship of bronchiectasis to
airway obstruction and inflammation
in patients with chronic obstructive
pulmonary disease
Website:
www.eurasianjpulmonol.com Baris Seker, Burcu Arpinar Yigitbas, Celal Satici, Sibel Yurt, A. Filiz Kosar
DOI:
10.4103/ejop.ejop_17_19
Abstract:
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and bronchiectasis are diseases
of respiratory tract with significant mortality and morbidity. These two diseases can be seen together
occasionally and are thought to change each other's course by adversely affecting the prognosis.
The aim of our study was to identify the signs of bronchiectasis in COPD patients, to investigate
its possible effects on disease prognosis, and to evaluate these signs for diagnostic convenience.
MATERIALS AND METHODS: This prospective study included a total of stable 60 moderate/severe
COPD patients who were admitted to Yedikule Chest Diseases and Chest Surgery Training and Research
Hospital between January 2015 and February 2016. The patients were divided into two groups according to
the presence of bronchiectasis as confirmed radiologically: 35 patients in the bronchiectasis group and 25
patients in the control group. Demographic data of the patients were questioned and systemic inflammation
parameters, spirometric measurements, blood gas analysis, and clinical evaluation findings were recorded.
RESULTS: Bronchiectasis was detected in 58.3% of COPD patients. Patients in two groups are similar
in sociodemographical, spirometrical and clinical parameters (P > 0.05). Laboratory tests showed similar
result in between two groups but carbon dioxide(CO2) values in the blood gas analysis were found to be
higher in the bronchiectasis group (P < 0.05). The increase in the number of bronchiectasis segments
was shown to reduce the FEV1/FVC (P < 0.05). In the overall evaluation, FEV1%, mMRC, FVC% and
CRP levels were found to be associated with exacerbations in COPD (P < 0.05). The use of antibiotics
increased as FEV1% and FEV1/FVC levels of patients decreased (P < 0.05). In addition, sputum
polymorphonuclear leukocyte (PMNL) values were correlated with spirometric values and as sputum
PMNL values increased, spirometric values were found to decrease (P < 0.05 for FEV1% and FVC%).
CONCLUSION: Bronchiectasis is common in COPD patients. In two divided groups, blood gas carbon
dioxide values, which affect mortality, were shown to be higher in the bronchiectasis group. This is
a new addition to literature that bronchiectatic COPD patients are experiencing different respiratory
failure patterns affecting mortality. Diffuse type bronchiectasis has more effect in spirometric results
of COPD patients. Also, airway obstruction in COPD is well correlated with elevated sputum PMNL
Department of Chest values which represent airway inflammation and if this is combined with high clinical suspicion it
Disease, Yedikule guides to a cost effective way for guiding radiological investigations for bronchiectasis.
Research and Training
Hospital for Chest Keywords:
Diseases and Chest Bronchiectasis, COPD, diagnosis, inflammation, mortality, prevalance
Surgery, Istanbul, Turkey

Address for
correspondence: Introduction by permanent destruction of connective
Dr. Baris Seker, tissue, muscular, and elastic elements
Yedikule Chest Disease
and Thoracic Surgery
Training and Research
B ronchiectasis is permanent dilation of
the bronchi and bronchioles caused
surrounding the bronchi and bronchioles
due to various reasons.[1] It causes the loss of
lung function in obstructive and restrictive
Hospital, Belgradkapi Yolu
Street, No:1, Zeytinburnu, This is an open access journal, and articles are type.[2] The use of high‑resolution computed
Istanbul, Turkey. distributed under the terms of the Creative Commons
E‑mail: dr.barisseker@ Attribution‑NonCommercial‑ShareAlike 4.0 License, which How to cite this article: Seker B, Yigitbas BA,
gmail.com allows others to remix, tweak, and build upon the work Satici C, Yurt S, Kosar AF. The relationship of
non‑commercially, as long as appropriate credit is given and bronchiectasis to airway obstruction and inflammation
Received: 25-04-2018 the new creations are licensed under the identical terms. in patients with chronic obstructive pulmonary disease.
Revised: 05-05-2018 Eurasian J Pulmonol 2019;21:21-8.
Accepted: 13-08-2018 For reprints contact: reprints@medknow.com

© 2019 Eurasian Journal of Pulmonology Published by Wolters Kluwer - Medknow 21

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Seker, et al.: COPD and bronchiectasis
tomography (HRCT) has led to a higher number of
diagnosis.[3] In advanced chronic obstructive pulmonary
disease (COPD) patients, the prevalence of bronchiectasis
may vary from 30% to 50%.[1,4,5]
In patients with COPD, the presence of bronchiectasis has
been shown to accelerate the loss of pulmonary function.[6,7]
Therefore, even distinguishing patients with bronchiectasis
is important, as it may cause respiratory failure and the rapid
progression of the disease in the course of COPD.[8] This
condition may be due to frequent exacerbations, colonization
of potential pathogenic microorganisms (PPM), and
systemic inflammation.[9] COPD has also been shown to
have more severe course in smokers with bronchiectasis.[10,11]
Bronchiectasis is important due to the common
association with infections and it is a common pathology
secondary to infections in developing countries such as
Turkey, and also controversial data were reported about
the frequency and course of the disease.
In the present study, we aimed to evaluate the
prevalence and clinical importance of bronchiectasis in
moderate‑to‑very severe COPD patients.
Methods
Study population
This study was designed as a prospective cohort.
Moderate‑to‑severe and very severe COPD patients (forced
expiratory volume in 1 s [FEV1]/forced vital capacity [FVC]
<70%, FEV1 <80% up to FEV1 <30%) according to the
global initiative for obstructive lung disease (GOLD) 2017
COPD airway obstruction classification, with a history of
at least 10 packs/year of cigarette smoking, who admitted
to our chest diseases outpatient clinic between February
01, 2015, and January 01, 2016 and accepted to participate
were included in the study.[12] Patients with COPD, who
have had unstable disease in the past 6 weeks (did not
take oral/intravenous antibiotics and/or steroids in the
past 6 weeks), unstable angina or unstable arrhythmia,
previous allergic asthma or bronchiectasis diagnosis,
previous stroke history with persistent risk of aspiration,
and severe gastroesophageal reflux disease were not
included in the study, as those may affect the frequency
of exacerbations and the prevalence of bronchiectasis.[13]
A total of 74 patients with COPD were included in the
study, 14 of them were excluded from the study before
registering the patient data, due to the lack of tests and/or
telephone contact and/or to refuse to follow‑up/test.
A total of 60 patients’ data were collected. Follow‑up
period for mortality was 3 years, and ranges from 1 to
10 months for exacerbation and other medical histories.
The study was approved by the Local Ethics Committee
and was conducted in accordance with the principles of
22 Eurasian Journal of Pulmonology ‑ Volume 21, Issue 1, January-April 2019
the Declaration of Helsinki. Written informed consent
was obtained from each patient.
Data collection and diagnosis
Patients with COPD, who met the inclusion criteria,
were questioned and recorded for age, gender, history
of smoking, comorbidities, body mass index, modified
medical research council dyspnea score (mMRC), and
treatments for COPD (e.g., whether they use respiratory
devices). COPD‑related comorbidities were grouped and
recorded as: (1) Respiratory diseases, (2) cardiovascular
diseases, (3) malignancy, (4) endocrine diseases,
(5) gastrointestinal diseases, and (6) renal diseases.
The frequency of exacerbation was obtained from the
history of patient and hospital records. Sputum culture
and gram staining were requested from patients within
3 days from the day of admission. In gram staining, <10
epithelial cells (quality sputum sample) were accepted
as valuable. [14] Blood gas analysis, hemogram, and
biochemical parameters of all patients were collected
at admission. Spirometry tests were performed in
accordance with the European Respiratory Society
guidelines for spirometry.[15,16] Radiological examinations
were performed with the HRCT. The existence of
bronchiectasis was confirmed and scored by two‑blinded
radiologists, using the Reid classification and Reiff scoring,
in addition, emphysema was also defined.[17‑19] Hospital
admissions, devices used for respiratory failure, and other
clinical data were obtained from the patient during visit
or from medical records. After collecting all the data, the
patients were interviewed again and the frequency of
exacerbation and antibiotic use during the period was
questioned. The duration of the follow‑up was ranged
from 1 to 10 months according to the patients’ control
examination visit. Fourteen patients were excluded from
the study before registering the patient data [Figure 1].
Statistical analysis
Descriptive statistics for numerical variables and frequency
distributions for categorical variables were used in the
evaluation of the data of the study. Before analyzing data,
the suitability of normal distribution of numerical variables
Figure 1: Flow chart of patient inclusion
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Seker, et al.: COPD and bronchiectasis

was investigated, and parametric methods were used to
variables with normal distribution, and nonparametric
methods were used to variables with abnormal distribution.
Pearson correlation and Spearman Rho correlation
coefficient were used to determining whether there is
a relationship between two numerical variables. The
relationship between two categorical variables was
examined by the Chi‑square test. The difference between
the two groups was examined by the independent samples
t‑test and Mann–Whitney U test and the difference between
more than two groups was examined by one‑way analysis
of variance, P < 0.05 was considered statistically significant.
SPSS version 16.0 software (SPSS for Windows, Version
16.0. Chicago, SPSS Inc.) program is used for analysis.
bronchiectasis (n = 25). The two groups had a similar
distribution in terms of sociodemographic data. Other
demographic data of the patients are summarized in
Table 1. Radiological examination showed that the most
common type of bronchiectasis was cylindrical (97%)
and both emphysema and bronchiectasis were present
in 54% of patients.
Patients completing research is 60 and during 3 years
mortality follow‑up, 13 patients died, and 8 of them
had bronchiectasis and COPD together. Mortality risk in
COPD patients is significantly increased in the presence
of bronchiectasis with an odds ratio (OR) of 1.18 (95% of
confidence interval = 0.33–4.17).

Results When comparing two groups in terms of spirometric

values, all values were similar, including those
Bronchiectasis was detected in 58.3% of COPD patients particularly reflect obstruction as FEV 1 % and
and patients were divided into groups as COPD FEV1/FVC (P = 0.27, P = 0.25, respectively). The mean
patients with bronchiectasis (n = 35) and without of FEV1/FVC was observed to be decreased as the

Table 1: Demographic, clinical and laboratory characteristics of the patients included in the study
COPD patients with COPD patients without bronchiectasis P
bronchiectasis (n=35; 58.3%) (control) (n=25; 41.7%)
Age, mean±SD 62.09±10.758 61.12±8.918 0.715
Gender, n (%)
Male 32 (53) 22 (13) N/A
Female 3 (2) 3 (2)
BMI 24.66±4.755 27.1±5.224 0.297
Smoking periods (pack year), n (%)
<20 3 (2) None N/A
>20 32 (53) 25 (15)
mMRC, mean±SD 1.94±1.327 1.68±1.249 0.442
Comorbidity, n (%)
CVS 12 (7) 14 (8) N/A
Other 6 (4) 4 (2)
FEV1 ml, mean±SD 1.39±0.613 1.50±0.436 0.439
FEV1%, mean±SD 46.87±21.909 52.54±15.778 0.274
FEV1/FVC %, mean±SD 58.07±11.573 61.44±10.484 0.253
FVC (ml), mean±SD 2.20±0.737 2.26±0.639 0.742
FVC %, mean±SD 58.33±21.454 62.45±14.979 0.412
Hct %, mean±SD 43.72±6.29 43.74±5.85 N/A
Plt (k/mm³), mean±SD 220.77±62.301 236.32±56.984 N/A
Leukocyte (k/mm³), median (minimum−maximum) 9.3 (4−19) 9.4 (3.7−33) 0.970
Albumin mean (g/dL)±SD 4.21±0.34 4.25±0.372 0.649
Sedimentation (mm/h), median (minimum−maximum) 15 (1−67) 15 (2−58) 0.563
CRP (mg/dl), median (minimum−maximum) 6.1 (0−70) 4.8 (0−48) 0.869
pH, mean±SD 7.42±0.038 7.43±0.037 0.388
pO2 (mmHg), mean±SD 84.59±16.874 78.96±16.356 0.202
pCO2 (mmHg), median (minimum−maximum) 41 (30−67) 37 (30−51) 0.038*
HCO3 (mEq/L), mean±SD 26.68±4.243 25.36±3.041 0.189
Tuberculosis sequelae, n (%)
Present 23 (65) 7 (28) N/A
Absent 12 (35) 18 (72)
*P<0.05. Parameters with normal distribution are shown with mean±SD, parameters with abnormal distribution are shown with median, minimum−maximum.
BMI: Body mass index, mMRC: Modified medical research council dyspnea score, FEV1: Forced expiratory volume in 1 s, FVC: Forced vital capacity volume,
FEV1%: The ratio of FEV1 to predicted values, FVC %: The ratio of FVC to predicted values, FEV1/FVC: The ratio of FEV1 to FVC, CVS: Cardiovascular
system, Hct: Hematocrit, Plt: Platelet, CRP: C‑reactive protein, pO2: Partial oxygen pressure, pCO2: Partial carbon dioxide pressure, pH: Blood acid‑base level,
HCO3: Blood bicarbonate level mEq/L, SD: Standard deviation, N/A: Not applicable, COPD: Chronic obstructive pulmonary disease

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Seker, et al.: COPD and bronchiectasis

Table 2: The investigation of the difference between

exacerbation history in terms of modified medical
research council dyspnea score and spirometry
values for all chronic obstructive pulmonary disease
patients
n Mean±SD P
mMRC
Without exacerbation 24 1.38±1.209 0.023*
With exacerbation 36 2.14±1.268
FEV1
Without exacerbation 24 1.59±0.519 0.075
With exacerbation 36 1.33±0.544
FEV1/FVC
Without exacerbation 24 62.38±8.060 0.074
With exacerbation 36 57.54±12.564
FEV1%
Figure 2: The demonstration of increasing degrees of obstruction with Without exacerbation 24 55.91±20.000 0.030*
bronchiectasis extension With exacerbation 36 44.77±18.343
FVC
number of involved bronchiectatic bronchial segments Without exacerbation 24 2.35±0.756 0.226
increased (P < 0.05) [Figure 2]. With exacerbation 36 2.13±0.643
FVC %
In addition, inflammation markers (platelet and leukocyte Without exacerbation 24 66.24±21.481 0.038*
level, albumin, sedimentation, C‑reactive protein [CRP]) With exacerbation 36 55.92±16.155
*P<0.05. mMRC: Modified medical research council dyspnea score,
were found at similar levels between two groups (P > 0.05). FEV1: Forced expiratory volume in 1 s, FVC: Forced vital capacity volume,
Furthermore, exacerbation frequency and follow‑up FEV1%: The ratio of FEV1 to predicted values, FVC %: The ratio of FVC
antibiotic usage were not different (P > 0.05). mMRC to predicted values, FEV1/FVC: The ratio of FEV1 to FVC, SD: Standard
deviation
value in patients with bronchiectasis (1.92) was higher
than the control group (1.68), but this was not statistically
significant. In arterial blood gas examination, CO2 was Table 3: The investigation of the difference between
follow‑up antibiotic usage status in terms of
found to be significantly higher in the bronchiectasis spirometric values (independent sample t‑test)
group than the control group (P < 0.05).
n Mean±SD P
FEV1
In the evaluation of the determinants of exacerbations in
Not used 34 1.57±0.529 0.079
all patients; the mMRC score, was higher and the FEV1% Used 17 1.28±0.612
and FVC% were lower in patients with exacerbation FEV1/FVC
history (P < 0.05) [Table 2]. The patients with a lower Not used 34 62.20±10.556 0.008**
mean of FEV1/FVC and FEV1% were found to use more Used 17 53.40±11.233
antibiotics than the higher ones when the antibiotic FEV1%
usage was evaluated in the follow‑up of all COPD Not used 34 54.56±19.693 0.046*
patients (P < 0.05) [Table 3]. Used 17 42.48±20.247
FVC
When the sputum polymorphonuclear leukocyte (PMNL) Not used 34 2.34±0.674 0.379
values were examined together with spirometric data for all Used 17 2.16±0.740
patients in terms of airway inflammation and obstruction FVC %
all spirometric values were found to be worse in patients Not used 34 64.40±18.444 0.148
with sputum PMNL values > 10 (P < 0.05) [Figure 3]. Used 17 56.17±19.688
Furthermore, in the sputum culture examination, *P<0.05, **P<0.01. FEV1: Forced expiratory volume in 1 s, FVC: Forced vital
capacity volume, FEV1%: The ratio of FEV1 to predicted values, FVC %: The
46 patients were able to give sputum and bacterial growth ratio of FVC to predicted values, FEV1/FVC: The ratio of FEV1 to FVC, SD:
was observed in 9 of them. In patients with bacterial Standard deviation

growth, 6 of them had bronchiectasis.

Despite having the same inflammation and spirometric
Discussion parameters, in respiratory failure evaluation, partial
carbon dioxide levels (pCO2) were higher in COPD
In the present study, the prevalence of bronchiectasis patients with bronchiectasis (P < 0.05). Studies in COPD
in patients with moderate‑to‑severe COPD (%58) was patients have shown the effect of carbon dioxide levels
found compatible with the meta‑analysis (54%).[5] on mortality.[20] However, there was no significant change
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Seker, et al.: COPD and bronchiectasis
Figure 3: Demonstration of association between airway obstruction and sputum
inflammation marker polymorphonuclear leukocyte count (P < 0.05)
in partial oxygen levels, which has been shown in other
researches (P > 0.05).[21,22] Furthermore, mortality risk
in COPD was significantly increased with an OR of
1.18, in the presence of bronchiectasis. It is considered
with this combined data obtained from the study that
bronchiectasis may increase mortality.
In addition, we showed that in both groups of patients,
more sputum PMNL counts means more inflammation
and obstruction, and more obstruction means more
antibiotic usage, and for bronchiectasis group, if
involved segments are increased, spirometric values
are decreased.
According to this study in light of these data, we
deduce that, an increase in the number of bronchiectatic
segments and sputum PMNL levels were correlated with
lower spirometric values which are associated with the
frequency of exacerbations in COPD, and obstruction
was thought to be more prominent, and these patients
were more likely to use antibiotics supporting other
studies. [18] In similar studies, radiological scoring
systems including the status of segments have been
used. [23] These scoring systems were found to be
consistent with the spirometric staging of COPD. In
the scoring system developed by Bhalla et al.[24] which
was used as a modified version in the mentioned
study; grade and extent of bronchiectasis, mucus
plug formation, peribronchial thickening, and level of
division which bronchiectasis extends are evaluated.
The HRCT score was found to be negatively correlated
with spirometric FEV1, FVC and FEV1/FVC by the
scoring system used in the mentioned study (P < 0.001).
In another study, it was showed that FEV 1 was
decreased as the number of lobe with bronchiectasis
was increased.[25] In this study, a significant relation was
found between sputum PMNL values and spirometry
values, and this was in parallel with interleukin‑6 (IL‑6),
Eurasian Journal of Pulmonology ‑ Volume 21, Issue 1, January-April 2019 25
IL‑8, and total cell counts in a similar study reflecting
airway inflammation and frequent exacerbation. [26]
With this data, we suggest, sputum PMNL level to
be used for the follow‑up of bronchiectasis or as a
screening parameter for the radiologic investigation
of the presence of bronchiectasis in patients with
COPD. This condition may be evaluated with other
further supporting studies and may be considered as a
cost‑effective test, particularly in developing countries
with a high prevalence of bronchiectasis and disease
burden.
Bronchiectasis as a tuberculosis sequelae was included in
the study due to the frequent observation of tuberculosis
in Turkey, although upper lobe bronchiectasis due to
tuberculous sequelae was excluded in some studies.[22,23]
It is considered that this condition may explain the
difference in the spirometric data, inflammation levels
and other parameters between our study and other
studies. Because we know that bronchiectasis due to
tuberculous sequelae has different localization than
other types of infectious sequelae as tuberculosis most
commonly affecting upper lobes or upper portions of
lower lobes that has better drainage and low risk of
mucus plugging.[27]
For discussion about radiological examination
and obstruction levels, the most common type of
bronchiectasis was cylindrical, widespread involvement
was present in 46% of patients. Only upper lobe and
only lower lobe involvement ratios were similar. In
similar studies, the ratio of cylindrical bronchiectasis
was reported as 91%, and localization was mostly in
lower lobes.[28] In this study, the rate of detection of
emphysema was 54% in patients with bronchiectasis
which was 76%, 82%, and 80% in similar studies,
respectively.[21,23,29] The mean of FEV1% was 47 ± 22
standard deviation (SD) in bronchiectasis group and
52.5 ± 16 SD in the control group in the evaluation
of spirometric values. The nearest study to these
values was conducted with 99 COPD patients and
mean FEV1% difference was found to be similar. FEV1
was found 45% in patients with bronchiectasis and
COPD, and 54% in isolated COPD patients, this was
statistically significant (P < 0.001).[21] In contrast to this,
we found that FEV1% was not significantly different
between the two groups despite numbers (P > 0.05).
In similar studies, mean FEV1% was lower in COPD
patients with bronchiectasis, FEV1 42% (Tulek et  al.),
FEV 1  45%  (Garcia et  al.) when compared to COPD
only patients (P < 0.01).[21,23,28] In this study, FEV1/FVC
value was found to be 58% in the bronchiectasis group
and 61.4% in the control group, and in contrast to
similar studies, this difference was not statistically
significant (P > 0.05). As mentioned previously,
spirometric values were thought to be related to the
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Seker, et al.: COPD and bronchiectasis
groups with emphysema and bronchiectasis included
in the study. In this study, the patients with emphysema
together with bronchiectasis are less frequent than
similar studies. It was considered that this condition may
affect FEV1% and FEV1/FVC values. There is a study
that suggests FEV1 decline is more prominent in the
emphysema group, and the presence of emphysema has
been associated with lower lung functions (P < 0.001).[29]
It is also considered that cases with tuberculosis sequelae
could affect the spirometry in the study. In a study
related to this situation, it was stated that FEV1 was
lower in patients with bronchiectasis due to tuberculosis;
although, this study did not identify the group of COPD
patients.[30]
There are three studies about COPD and bronchiectasis
in Turkey. The first of these was conducted in 2006. In
this study, the prevalence of bronchiectasis in COPD
patients was 31% (93 patients in total) and it was stated
that the duration of stay in intensive care unit and
hospitalization could be prolonged in COPD patients
with bronchiectasis, and did not affect mortality.[31]
Another study was conducted in 2013. This study noted
the importance of the HRCT for phenotyping and disease
management in COPD patients and that bronchiectasis
may be a distinct phenotype of COPD.[23] The last study
is a review, written in 2014. In this review, based on
the data from many references, it has been reported
that widespread use of the HRCT increased the rate
of bronchiectasis detection, and COPD patients with
bronchiectasis have a worse prognosis, longer duration
of exacerbations, and a higher rate of PPM colonization.[32]
There is no follow‑up study of patients with COPD and
bronchiectasis in Turkey, and by this study, we showed
the mortality effect of bronchiectasis and the importance
of follow‑up. Furthermore, we suggest including
bronchiectasis due to tuberculosis sequelae patients for
research purposes because of disease burden.
The “exacerbator” group in the phenotypes of COPD,
defined in the studies of COPD disease, includes the patients
with 2 or more exacerbations per year.[33,34] In these patients,
risk factors for exacerbation were detected as senility, low
FEV1 and oxygen requirement, previous exacerbation
history, more severe systemic and airway inflammation,
bacterial load of sputum in stable phase, chronic bronchitis,
and some comorbid diseases (cardiovascular system,
anxiety‑depression, myopathy, and reflux disease)[34] and
when bronchiectasis patients are examined the level of
inflammation in sputum specimens was found to be high,
even in the stable phase.[35] We can get a conclusion from
these two studies that bronchiectasis causes an airway
inflammation that causes an exacerbator phenotyped
COPD patient. In this study, PMNL count in Gram
staining that reflects the level of airway inflammation;
CRP, albumin, sedimentation, Plt, leukocyte that reflect
26 Eurasian Journal of Pulmonology ‑ Volume 21, Issue 1, January-April 2019
the systemic inflammatory response; and symptom
query, mMRC value, and follow‑up antibiotic usage
which are clinical reflections of these conditions were
obtained from the patient data.[36‑39] We examined these
values to get a conclusion about bronchiectasis if present
causes an exacerbator phenotype in COPD. The number
of patients who had 2 or more exacerbations was 17, and
12 of them had bronchiectasis, but this was not significant
enough to define bronchiectasis as an exacerbator COPD
phenotype (P > 0.05). In a meta‑analysis, patients with
bronchiectasis had 1.5 times more exacerbations than
COPD only patients.[5]
Similar studies have examined PPM colonization, which
has been reported to be associated with bronchiectasis
and also Pseudomonas colonization was more frequent in
COPD patients with bronchiectasis.[21,28,40] In this study,
patients with bronchiectasis were more likely to need
antibiotics during the follow‑up, but sufficient data could
not be obtained on this issue. The reason of this condition
was considered as requirement for larger sampling and
longer follow‑up.
To tell more about examining these two groups
differences clinically, it was considered that using COPD
assessment test (CAT) scoring which also evaluates the
sputum condition may be more appropriate in these
patients, as the increase in sputum frequency is more
suitable for reflecting the score of the disease status of
patients with bronchiectasis. In similar studies, CAT
scoring was not used as seen in the meta‑analysis. We
suggest using the CAT score for assessing the clinical
condition of these patients.
In this study, sample size and research duration were
our limitations. Some patients did not want to complete
the study because of social problems and patients with
more severe COPD were not suitable to include, because
of improper medical records or severe disease status. We
conducted this study in a preset schedule, and this was
also a limitation, because some patients may have more
attacks during this unfollowed period.
Conclusion
Significant proportion of patients with COPD is associated
with bronchiectasis. This shows us that many patients
with COPD, especially severe patients, need further
evaluation for other respiratory problems because they
may effect some important clinical parameters and so the
mortality. Furthermore, bronchiectasis is an independent
mortality risk factor for patients with COPD as expressed
in meta‑analyses.[5,41]
Patients with bronchiectasis and COPD, when
bronchiectasis associated with tuberculosis were
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Seker, et al.: COPD and bronchiectasis
included, were considered to have similar behaviors
with the current GOLD staging of COPD in terms
of spirometric values and exacerbation. We suggest
using also bronchiectasis due to tuberculosis patients
in studies and meta‑analysis for developing countries
and tuberculosis prevalent countries. This may reflect
better diversity of COPD patients with bronchiectasis
in these countries.
COPD with diffuse bronchiectasis causes worse
spirometric values. This causes more functional loss
and respiratory failure. In this type of patients, we
have more inflammation in the airway as pathology of
bronchiectasis also suggest this and these patients have
more exacerbation and more antibiotic usage.
We suggest more patients should be included in new
studies with more follow‑up times, and patients should
be assessed with CAT score that better reflects their
sputum production. Tuberculosis‑prevalant countries
need to evaluate bronchiectasis due to tuberculosis
sequelae and integrate research according to needs.
Furthermore, it is also considered that in frequent
exacerbator patients with suspected bronchiectasis,
sputum PMNL value which reflects airway inflammation
should be checked, and if it is detected high, detailed
radiological investigations should be done, and this
should be used as a cost‑effective screening test.
Acknowledgment
The authors would like to thank to Doctor Mehmet
Tutar and TUSAD(Turkey Respiratory Research Society)
Academy for contribution about radiologic evaluation;
statistical analysis, technical support and language
support respectively.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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